Medical Management Of Vulnerable And Underserved Patients Principles Practice And Populations 2nd Edition Talmadge E. King Jr, Margaret B. Wheeler, Andrew B. Bindman, Alicia Fernandez, Kevin Grumbach, Dean Schillinger, Teresa J. Villela - Solutions

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Have you experienced compassion satisfaction? What personal factors, patient factors, and work factors promote compassion satisfaction in your own work?
Burnout among health-care providers is correlated with lower rates of patient adherence to recommendations, slower surgical healing time, and decreased patient satisfaction. How might burnout lead to these outcomes?
How does working with vulnerable populations influence your personal need for self-care?a. Are there challenges that are unique to working with these populations?b. Are there features of working with vulnerable populations that help you remain engaged in your work?
Which aspects of care transitions are more challenging for homeless patients? What interventions could assist such patients as they are discharged from the hospital?
Reflect on your experiences with patients who lack decision-making capacity in the hospital. Are patients who cooperate with our recommended plans of care less likely to have their decision-making capacity evaluated?
What preparations or follow-up plans should providers make for a patient who leaves AMA or AWOL from the hospital? When a patient leaves despite your recommendations, should he or she receive the same standard of discharge planning?
What strategies can providers employ to reasonably ensure that the medical care and treatment offered is concordant with the patient’s needs, desires, and values?
Consider any patient admitted to the hospital. What vulnerabilities might he or she experience? How are these vulnerabilities, common to many patients, compounded among patients who do not speak English well or patients with an underlying mental illness?
You are admitting a patient from the emergency department who does not speak English and your hospital does not have a suitable interpreter to facilitate the interaction. What strategies might you pursue to get further information?
Consider from your own experience how an acute illness and the recovery from that illness affected the life and family of a loved one or friend. How might financial limitations have affected the outcome?
How would you counsel a 21-year-old African-American gay man who is sexually active in reducing his risk of acquiring HIV?
What are some approaches that might be useful in linking to and engaging in care patients who are triply diagnosed with HIV/AIDS, depression, and addiction to cocaine?
Discuss strategies that could increase HIV testing rates among women.
What are key components for insurance documentation of a mobility aid?
What is ASL? How does one use an ASL interpreter?
What steps can clinicians take to make their offices more accessible to persons with sensorimotor disabilities?
Name three examples of assistive devices for persons with lower extremity mobility impairments, hearing loss, or low vision.
What is a disability?
What are topics to discuss with pregnant women regarding their oral health status?
If Juana walked into your office, what recommendations would you give her regarding her oral care? What concerns would you have with her children, understanding Juana’s own medical and social history?
In what ways can rural health-care providers impact oral health in their communities?
Why is the treatment of dental disease important, considering the goal of treating the whole patient?
Compare and contrast the health benefits of quitting smoking with other treatments that are often prescribed.
Practice and role-play with your neighbor using the five A’s, five R’s, and STAR techniques.
Some argue that without the production and sale of tobacco, our economy would suffer tremendously and that public policies to restrict tobacco use hurt the economy. Discuss.
Discuss ways in which novel tobacco products may change current patterns of tobacco use. Discuss how the regulation of these products might affect patterns of tobacco use.
Why do you think that health-care professionals in your field do not tackle smoking cessation as frequently as they should? What strategies could you use in your setting to improve smoking cessation efforts?
If you were caring for Mr. Wayland as an inpatient, how could you use the described interviewing approaches during his inpatient stay? What is a realistic goal in addressing his motivation to change his substance use?
Five minutes into your first visit, a new patient accuses you of minimizing her pain and belittling her as an“addict.” How do you begin to build trust?
When seeing a patient with alcohol and cocaine use disorders, HIV infection, depression, and homelessness, how do you focus your efforts? What resources can you mobilize to help in this patient’s care?
If JP’s pain were more severe or persistent, would you have prescribed long-acting opioids? Why or why not?If so, how would you have monitored his care?
What practice tools can help you manage pain once it is recognized?
What can you do in your own practice to make it easier for your patients to talk to you about pain?
Discuss the reasons why chronic pain is more prevalent in medically underserved populations.
Esmeralda’s mother has been your patient for 5 years.She happily reports to you that her both daughters have been losing weight over the last year. Your medical record shows that she has gained 5 pounds in the last year and her diabetes control has worsened(HbgA1C has risen from 7.5 to 9.0).
Describe the steps a health-care provider should take to help a patient lose weight.
Discuss three of the many factors that make it difficult for you or someone you know to lose weight. How might you overcome those difficulties?
Discuss ways in which y u c uld appr ach b th trauma and vicari us traumatizati n fr m a “resiliency r strength-based” framew rk. H w w uld this framew rk change the ways y u care f r patients and y urself?
Discuss ways in which y u c uld intr duce the t pic f trauma and its effects with adult patients and with children and parents in pediatric practice.
Discuss h w min rity status (race/ethnicity, religi n, sexual rientati n, gender identity, and ther fact rs) affects individual r c mmunity risk f r vi lence and trauma.
Imagine you have a patient who was severely abused as a child and presents to the health-care setting in repeated abusive relationships. How would you approach this patient? How might you sustain your morale while working with this patient over time?
Discuss ways you have introduced (or could introduce)the topic of IPV with patients and then role play, asking about IPV and being supportive to a patient affected by IPV. How would you change your approach in a pediatric setting?
Discuss how speaking limited English (or one’s culture, race, ethnicity, sexual orientation) might affect one’s experience with IPV and one’s interaction with the health-care system.
Consider the approach to providing contraception in your current practice setting. Generate a list of three specific changes you could make to improve your patients’ access and compliance with contraception.
Ms. Chen is a 37-year-old woman with hepatitis C who comes to you seeking contraception. How would you counsel her about her options? What resources would you consult to determine the safety of contraceptive methods in a woman with a medical illness?
You are involved in the planning stages of a women’s clinic in a low-income community. What structural elements would you include to make your services more accessible to your target patient population?
H w might systemic barriers t accessing and receiving g d care be reduced LGBT patients? In y ur wn practice, what specific measures can y u take t pr -m te c mf rt and pen c mmunicati n?
Why is it ften hard t discuss sexual rientati n and sexual behavi r in a medical visit? What ab ut gender identity? Discuss ways y u might frame and discuss these issues with patients.
What can y u d in y ur practice t decrease discriminati n against transgender pe ple?
What types f challenges might a lesbian r gay man face when seeking health care? What is y ur r le in addressing these challenges?
Have you ever referred a patient to a colleague for a“language concordant consultation’? In what scenarios might you do so?
Does your institution provide professional interpreters(in-person or by telephone)? If yes, how are interactions with professional interpreters different from those with ad hoc interpreters?
Have you ever used an ad hoc interpreter? What did it feel like? What could you have done to improve the patient encounter?
Do you speak a language other than English? If yes, what do you think about your ability to adequately communicate with patients in that language after reading this chapter?
How does communication, or miscommunication, affect quality of care? (Try to elicit and synthesize both research evidence and personal experiences.)
What challenges and pp rtunities can y u identify t using the chr nic illness care m del and p pulati n-based interventi ns in rural practice?
Discuss the benefits f interpr fessi nal training f r rural health-care pr viders.
Am ng the benefits f rural practice, which d y u think might be m st relevant t health-care pr fessi nal students and trainees as they are deciding n future careers?
Y u are practicing in a c mmunity p pulated by refugees fr m a devel ping c untry. H w w uld y u set up a culturally c mpetent practice t care f r this c mmunity?What barriers t access w uld y u target and h w?
Describe health pr blems faced by immigrants and refugees.
Discuss the barriers t access t care faced by immigrant patients.
Discuss some of the barriers you have experienced in providing medical care to homeless patients. What principles do you use when developing a medical regimen for a homeless patient?
Given your experiences with the medical system, what system-level changes would you recommend to better the care that homeless patients receive? Are there ways to change your own system that would improve the health of your patients?
Develop a care plan for a homeless woman with newly diagnosed diabetes. What self-management recommendations do you make? With what medication do you start? Are there other resources you can use to help with adherence? Is it reasonable to make dietary recommendations to her?
What can providers do to improve transitions of care for individuals returning home from prison? What actions can they take to reduce patients’ risk of recidivism?
What social and medical barriers do individuals returning home from prison face? How does this impact health? Risk of recidivism?
What are the ways in which prison confers vulnerability both in prison and on release?
Why are prisoners considered a vulnerable population?
Describe how food insecurity can lead to a downward spiral of overall health.
Imagine you work in a clinic that takes care of vulnerable populations. How might you incorporate screening questions for food insecurity into your clinic workflow?Are there particular groups of patients you would focus on? If so, who? What recommendations you would make to a patient who is food
Discuss the difference between food insecurity and hunger. Can you explain how food insecure persons may adapt their behaviors to avoid hunger?
Using Web-based resources, look up the following questions: My apartment is flea infested. I have a 6-monthold child, can I safely have the place flea bombed? Every time I turn on the heat in the house I get a headache.Could there be a problem with the heater?
The city is proposing to expand a highway to lessen traffic congestion and improve commute times. The highway expansion is to occur through one of the poorest sectors of town. Will this affect the health of the local community? What can you do to make your opinions heard?
A 32-year-old African-American woman who you follow up for severe persistent asthma comes to your office after three emergency room visits in the past month.What are the important work and home environment issues that should be discussed and what interventions would you recommend?
A 22-year-old man, who is a recent immigrant from Mexico, comes to your office complaining of back pain. What are the important occupational issues that should be discussed at this visit and what interventions would you suggest?
How can providers and their professional organizations advocate for changes in the health-care system that meet the needs of dying patients?
How can barriers to hospice referrals and utilization be overcome to make this service more widely available?What alternative delivery models for quality palliative care are available?
What ethical principles should be considered in contemplating the Do Not Resuscitate (DNR) status for a patient in a persistent vegetative state if no prior advance directive is available? How might you assess the patient’s values and preferences if he or she is unable to express them? In such
An elderly homeless man has a recent diagnosis of adenocarcinoma of the lung. Given the grim prognosis of this disease, what structures and processes of care are needed to ensure the patient’s quality of life?
If Mrs. Jones was not eligible for Medicaid, what other resources would be available?
Describe the resources that are available in your community for elders like Mrs. Jones.
Using a patient or family member, calculate the cost of the Medicare Part D drug benefit. Will the drug benefit result in savings?
How would you design a system that provides health care based on a paradigm that views the family as the context for care?
What benefits and difficulties do you anticipate in adopting an approach to clinical care that sees patients in the context of their families?
Describe your personal beliefs and values about underserved families. How might these beliefs and values affect your clinical care?
Can you think of examples of health-care providers who successfully address the multiple determinants/contextual factors that influence health? How have they accomplished this?
What are the challenges to reorganizing a clinical practice to address the contextual factors that influence health?
What influence can a health-care provider have on a child’s health development trajectory?
Why may development be used as an indicator of children’s health?
How does a disease-based focus influence how we think about patients and their care?
Can you think of a time when role conflicts or goal conflicts interfered with a patient’s care? How might you manage team dynamics differently the next time you encounter a similar situation?
How should medical education change to create physicians effective at interdisciplinary collaboration?
What interdisciplinary programs are available in your clinical setting that focus on frequently hospitalized patients? How are they organized to improve care? In what ways are they successful and in what areas could they improve?
Think of a patient you have seen recently who has been frequently hospitalized. Could this patient benefit from an interdisciplinary team? What could each discipline bring to the care of this patient?
A clinic examines the diabetes control rate of its Latino patients. Should it stratify those patients by English proficiency? What about stratifying by the Spanish-speaking ability of the clinicians? What might this approach elucidate? See Fernandez,
A health plan decides to improve its flu shot rate by sending postcard reminders to all elderly patients. How might this approach improve flu vaccination rates? How might it fail? What else would you like to know before implementing this approach? After discussing this question, see Schneider,
Should safety-net health systems develop the infrastructure for delivering mHealth services “in-house” or contract such services with an outside vendor?
Clinicians need accurate and timely information to make decisions, but mHealth can add additional data(e.g., guidelines, clinician reminders, patient functional status information) to the process of care. How much information is too much? How should clinicians and health systems decide what mHealth
Should public health systems develop web- or texting-based educational supports for their patients, even though not all patients could use them? How should clinicians and administrators assess such services, so that scarce resources are used effectively without investing excessive time and money in
Given the widespread implementation of online patient portals, what do you think are the greatest challenges for use among (1) vulnerable patients and (2) providers in safety-net systems? How do you think the initial challenges with adoption will differ from longer term engagement/use?

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Medical Management Of Vulnerable And Underserved Patients Principles Practice And Populations 2nd Edition Talmadge E. King Jr, Margaret B. Wheeler, Andrew B. Bindman, Alicia Fernandez, Kevin Grumbach, Dean Schillinger, Teresa J. Villela - Solutions

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